CN107569752B

CN107569752B - Nasal delivery device

Info

Publication number: CN107569752B
Application number: CN201710131575.0A
Authority: CN
Inventors: P·G·杰佩斯兰德; M·勒克莱尔; R·A·马莫德; S·西温斯基; J·戈登; J·菲斯克
Original assignee: Optinose AS
Current assignee: Aptinos Co ltd
Priority date: 2012-02-24
Filing date: 2013-02-25
Publication date: 2021-06-29
Anticipated expiration: 2033-02-25
Also published as: US20190290863A1; US20240316297A1; JP2015511158A; EP3799909A1; JP6243360B2; CN107569752A; MX2014010144A; IN2014DN07609A; EP4406572A2; AU2013223972A1; ZA201406597B; HK1250225A1; ES2847152T3; CN104428025B; EP3799909C0; SG10201600092UA; CN104428025A; US11033696B2; CA2865352C; DK2817052T3

Abstract

A nasal delivery device and method for delivering a substance to a nasal airway of a subject, the delivery device comprising: a nosepiece (117) for mounting to a nasal cavity of the subject; a mouthpiece (119) into which the subject exhales in use; a delivery unit comprising an actuation portion manually movable to actuate the delivery unit to deliver the substance from the nosepiece; and a valve assembly (127) fluidly connected to the nosepiece and the mouthpiece, wherein the valve assembly comprises a body element (128) and a valve element (131) movably mounted to the body element, the valve element being movable between closed and open configurations by manual movement of an actuating portion of the delivery unit to provide a flow of gas through the nosepiece while substance is delivered.

Description

Nasal delivery device

The application is a divisional application of a Chinese patent application named as a nasal delivery device, having an application date of 2013, 2 and 25 and an application number of 201380021180.5.

Technical Field

The present invention relates to nasal delivery devices and methods for delivering a substance, particularly a liquid in the form of a suspension or solution or a powder or vaccine containing a medicament, particularly a systemic or topical medicament, to the nasal airways of a subject.

Background

Referring to fig. 10, a nasal airway 1 includes two nasal cavities separated by a nasal septum, wherein the nasal airway 1 includes a plurality of orifices such as sinus orifice 3 and lacrimal duct orifice 5 and olfactory cells and is lined with nasal mucosa. The nasal airway 1 can communicate with the nasopharynx 7, the oral cavity 9 and the lower airway 11, wherein the nasal airway 1 selectively communicates with the anterior region of the nasopharynx 7 and the oral cavity 9 by opening and closing of the oropharyngeal membranes 13. The membrane 13, also commonly referred to as the soft palate, is shown in solid lines in the closed position, which can be achieved by providing a certain positive pressure in the oral cavity 9, for example by exhalation of the oral cavity 9, and is shown in broken lines in the open position.

There are many nasal diseases that require treatment. One such condition is rhinitis, particularly nasal mucositis, which may be allergic or non-allergic, is often associated with infection and interferes with normal nasal function. For example, typically 10% to 20% of the population suffers from allergic and non-allergic inflammation of the nasal airways, where nasal congestion, lacrimation, watery nasal discharge, sneezing and itching of the turbinate sponge tissue are the most common symptoms. It will be appreciated that nasal congestion impedes nasal breathing, encourages mouth breathing, resulting in snoring and sleep disturbance. Other nasal diseases include nasal polyps protruding from the sinuses, hypertrophy of the proliferative body, otitis media with secretion, sinus disease, and impaired olfaction.

Topical administration is advantageous in the treatment of certain nasal conditions, particularly where the nasal mucosa is the primary pathological route, for example in the treatment or alleviation of nasal congestion, and typically the agents administered topically include decongestants, antihistamines, cromolyn acids, steroids and antibiotics. Topical steroids have now been shown to be effective in nasal congestion, among the many known anti-inflammatory agents. Topical decongestants have also been proposed for relieving nasal congestion. Treatment of proliferative hypertrophy and chronic secretory otitis media with topical decongestants, steroids and antimicrobials has also been proposed, although controversial. In addition, topical administration has been used to treat or at least reduce inflammation of the anterior nasopharynx, sinuses, and eustachian tubes.

The agents may also be delivered systemically through the nasal passages, which provide a good route of administration for systemic delivery of drugs such as hormones (e.g., oxytocin and calcitonin) and analgesics (e.g., anti-migraine compositions) because of the high blood flow rate and large surface area of the nasal mucosa which facilitates rapid systemic absorption.

It is also expected that nasal administration will be advantageous for the administration of agents requiring rapid action, such as analgesics, antiemetics, insulin, antiepileptics, sedatives and hypnotics, and other drugs, such as cardiovascular drugs. It is envisaged that nasal administration will take effect quickly at a rate similar to injection but much faster than oral administration. Indeed, for the treatment of many severe conditions, nasal administration is advantageous over oral administration because gastric retention slows the onset of action after oral administration.

It is also contemplated that nasal administration may provide an effective delivery route for the administration of proteins and peptides made by modern biotechnology. For this substance, intestinal metabolism and liver first pass effects pose a significant obstacle to reliable and cost-effective delivery.

Furthermore, it is expected that nasal administration using the nasal delivery technique of the present invention will prove effective in the treatment of many common neurological disorders, such as alzheimer's disease, parkinson's disease, psychosis and intracerebral infections, for which treatment is not possible with the prior art. The nasal delivery technique of the invention allows delivery to the olfactory region, which is located in the upper region of the nasal cavity and represents the only region where the Blood Brain Barrier (BBB) can be bypassed and communication with cerebrospinal fluid (CSF) and brain is achieved.

It is also contemplated that the nasal delivery techniques of the present invention will allow for effective administration of the vaccine.

In addition to the administration of medicaments, rinsing the nasal mucosa with liquids, especially saline solutions, is commonly used to remove particulates and secretions and to improve the activity of the mucous villi of the nasal mucosa. These solutions may be used in combination with an active agent.

Accurate and reliable administration is critical for the administration of any drug, but is particularly important for the administration of potent drugs with a narrow therapeutic window, drugs with potentially severe adverse effects, and drugs for the treatment of severe and life-threatening conditions. For some conditions, such as in the case of diabetes, it is critical to personalize the administration to the patient for the particular situation. For diabetes and even many other conditions, administration is preferably based on actual real-time measurements. Currently, blood samples are most commonly used, but for some conditions molecular analysis of the subject's breath has been proposed instead of blood analysis. Breath analysis is currently used for the diagnosis of conditions such as helicobacter pylori infection, which can lead to gastric ulcers.

International patent application publication No. WO-A-2000/051672 discloses A delivery device for delivering substances, particularly medicaments, by bi-directional flow through the nasal cavity (i.e. airflow in one nostril, around the posterior margin of the nasal septum and out the other nostril in the opposite direction). This bi-directional airflow advantageously serves to stimulate the sensory nerves of the nasal mucosa, thus adapting the subject to delivery and providing a more comfortable delivery condition.

Disclosure of Invention

It is an object of the present invention to provide a nasal delivery device and method for delivering a substance to the nasal cavity of a subject, in particular to provide a relatively simple mechanically actuable delivery device.

In one aspect, the present invention provides a nasal delivery device for delivering a substance to a nasal airway of a subject, comprising: a nosepiece for mounting to a nasal cavity of the subject; a mouthpiece into which the subject exhales in use; a delivery unit comprising an actuation portion manually movable to actuate the delivery unit to deliver the substance from the nosepiece; and a valve assembly fluidly connected to the nosepiece and the mouthpiece, wherein the valve assembly comprises a body element and a valve element movably disposed to the body element, the valve element being movable between closed and open configurations by manual movement of an actuating portion of the delivery unit to provide a flow of gas through the nosepiece while substance is delivered.

In another aspect, the present invention provides a method of delivering a substance to the nasal airway of a subject, comprising the steps of: placing a nosepiece into a nasal cavity of the subject; the subject exhaling into a mouthpiece; providing a delivery device comprising: a delivery unit comprising an actuation portion manually movable to actuate the delivery unit to deliver the substance from the nosepiece; and a valve assembly fluidly connected to the nosepiece and the mouthpiece, wherein the valve assembly comprises a body element and a valve element movably mounted to the body element, the valve element being movable between closed and open configurations by manual movement of an actuation portion of the delivery unit; and manually moving an actuation portion of the delivery unit to move a valve element of the valve assembly between closed and open configurations relative to a body element of the valve assembly and provide a flow of gas through the nosepiece while the delivery of the substance is occurring.

Drawings

Preferred embodiments of the present invention will now be described, by way of example only, with reference to the accompanying drawings, in which:

FIGS. 1(a) and (b) show perspective views of a nasal delivery device according to a first embodiment of the present invention;

FIG. 2 shows an exploded perspective view of the delivery device of FIG. 1;

fig. 3 shows a vertical cross-sectional view of the delivery device of fig. 1 in a rest, non-actuated configuration;

FIG. 4 shows a vertical cross-sectional view of the delivery device of FIG. 1 in an actuated configuration;

FIG. 5 shows a partial vertical exploded cross-sectional view of the delivery device of FIG. 1 in an actuated configuration;

fig. 6(a) to (c) illustrate opening of the seal of the valve assembly by operation of the delivery unit of the delivery device of fig. 1;

FIG. 7 shows a graph of flow rate at a mouthpiece and pressure at the mouthpiece for one example device;

fig. 8(a) and (b) show partial vertical cross-sectional views of a nasal delivery device according to a second embodiment of the present invention in a resting, non-actuated configuration and an actuated configuration;

9(a) and (b) show partial vertical cross-sectional views of a nasal delivery device according to a third embodiment of the present invention in a resting, non-actuated configuration and an actuated configuration; and

fig. 10 schematically shows an anatomical diagram of the upper respiratory tract of a human subject.

Detailed Description

Fig. 1-7 illustrate a manually actuated nasal delivery device according to a first embodiment of the present invention.

The delivery device comprises a housing 115, a nosepiece 117 for placement in a nasal cavity of a subject, a mouthpiece 119 into which the subject exhales in use, such as to facilitate airflow into and delivery via the nasal airway of the subject as the subject exhales through the mouthpiece 119, and a delivery unit 120 which is manually actuable to deliver a substance to the nasal cavity of the subject.

The housing 115 comprises a body member 121, which in this embodiment is a substantially elongated tubular section comprising a hole 123 at one end thereof through which protrudes an actuating portion of the delivery unit 120, which in this embodiment is defined by the base of a substance receiving chamber 173 of a substance supply unit 169.

In this embodiment, body member 121 includes two

body sections

121a, 121b secured together.

In this embodiment, the

body sections

121a, 121b include interengaging tabs 124 and slots 125, here of the snap-fit type, and sealing elements 126 which act to close the airflow path at the junction of the

body sections

121a, 121 b.

In the present exemplary embodiment, the sealing element 126 is adhesively bonded, but may alternatively be mechanically bonded, for example by welding.

In an alternative embodiment, the sealing element 126 may be omitted.

The housing 115 further includes a valve assembly 127 which is fluidly connected to the nosepiece 117 and mouthpiece 119 and is operable between closed and open configurations, as shown in fig. 3 and 4, such as to provide an airflow in the form of a burst of air (in this embodiment) through the nosepiece 117 at the same time as actuation of the delivery unit 120, as described in more detail below.

The valve assembly 127 includes a main body member 128 containing a valve seat 129 defining a valve opening 130 and a valve member 131 movably disposed to the body member 128 between closed and open positions, as shown in fig. 3 and 4.

As shown particularly in fig. 3, the body member 128 includes a pivot portion 135, which in this embodiment is located on one side below the valve seat 129, to which one end 145 of the valve member 131 is pivotally connected, and a sliding surface 137, which in this embodiment is located on the other side above the valve seat 129, against which the other end 147 of the valve member 131 can slide.

The valve element 131 comprises an elongate arm 141, in this embodiment a flexible arm, one end 145 (in this embodiment the lower end) of which is pivotally connected to the pivot portion 135 of the body element 128, the upper other end 147 of which slidably engages the sliding surface 137 of the body element 128, and a valve element 149 supported by the arm 141.

In this embodiment, the arm 141 comprises a first, here lower, arm section 151 which is biased (here inwardly) so that the lower arm section 151 is inclined inwardly relative to the longitudinal axis of the housing 115 when the valve element 131 is in the closed rest position, and which is engageable by the substance supply unit 169 when manually actuated to move the valve element 131 to the open position, as will be described in more detail below.

In this embodiment, the arm 141 further comprises a second arm segment 153, here above, which engages the sliding surface 137 of the body element 128 and acts to bias the valve element 131 to the closed position.

In this embodiment, the valve member 149 includes a sealing portion 161, which in this embodiment is a flexible or resilient member, which acts to close the valve opening 130 defined by the valve seat 129 when the valve element 131 is in the closed position, and a support portion 163, which supports a central region of the sealing portion 161.

With this configuration, referring to fig. 6(a) to (c), in which the seal portion 161 is supported at the center, when the valve element 131 is moved to the open position, the support portion 163 biases the central region of the seal portion 161, as shown in fig. 6(b), causing the seal portion 161 to bulge outward in this central region and thus causing the seal portion 161 to engage the valve seat 129 only at the peripheral edge of the seal portion 161 until the seal portion 161 is abruptly and explosively released from the valve seat 129, as shown in fig. 6 (c).

This release pattern is believed to be particularly effective in this application where it is desired to achieve an initial burst of airflow because substantially the entire sealing surface of the seal 161 is released at one instant, as compared to an alternative pattern of peel release where a smaller portion of the sealing surface is released before the remainder of the sealing surface, which tends to create a smaller initial burst pressure.

In this embodiment, delivery unit 120 comprises an outlet unit 167 for delivering a substance into the nasal airway of a subject and a substance supply unit 169 for delivering a substance to outlet unit 167.

In this embodiment, the valve assembly 127 provides a pre-actuation performance of less than 5L/min when the user is developing an exhalation pressure of 3kPa, preferably less than 5L/min when the user is developing an exhalation pressure of 10kPa, more preferably less than 1L/min when the user is developing an exhalation pressure of 3kPa, more preferably less than 1L/min when the user is developing an exhalation pressure of 10kPa, more preferably substantially no airflow when the user is developing an exhalation pressure of 3kPa, and more preferably substantially no airflow when the user is developing an exhalation pressure of 10 kPa; pre-actuation performance is a measure of the ratio of the volume of air escaping from the device prior to actuation to the volume of air delivered into the mouthpiece 119.

In this embodiment, the delivery device is configured to provide post-actuation performance of at least 80% at a flow rate of 50L/min and an exhalation pressure of 3kPa, preferably at least 85% at a flow rate of 50L/min and an exhalation pressure of 3kPa, better at least 88% at a flow rate of 50L/min and an exhalation pressure of 3kPa, and more preferably at least 90% at a flow rate of 50L/min and an exhalation pressure of 3 kPa; post-actuation performance is a measure of the ratio of the volume of air delivered from the nosepiece 117 to the volume of air delivered into the mouthpiece 119.

Fig. 7 shows a graph of flow rate at the nosepiece 117 and mouthpiece 119 and pressure at the mouthpiece 119 for one example device.

In the present embodiment, the pre-actuation performance at a pre-actuation pressure of 5kPa is 1L/min.

In this example, the post-actuation performance was 88% at a flow rate of 57.1L/min.

In the present embodiment, the valve element 131 provides a burst of air flow when it is open, with an initial first burst phase followed by a prolonged second burst phase, wherein the maximum flow rate in the initial burst phase has a greater flow rate than the average flow rate in the prolonged burst phase, and the prolonged burst phase has a significantly longer duration than the initial burst phase.

In this embodiment, the maximum flow rate in the initial burst phase is at least 10%, preferably at least 15% and more preferably at least 20% greater than the average flow rate of a long burst phase corresponding to ten times the duration of the period during which the delivery unit 120 delivers the substance from the nosepiece 117.

In this embodiment, the delivery unit 120 provides a spray that begins 54 milliseconds (ms) after the opening of the seal 149 and ends 134ms after the seal 149 opens.

In one embodiment, the delivery unit 120 provides for delivery of the substance after opening of the seal 149.

In one embodiment, the delivery unit 120 provides for delivery of the substance in a period of less than about 250ms from the opening of the seal 149, preferably a period of less than about 200ms from the opening of the seal 149, more preferably a period of less than about 150ms from the opening of the seal 149, and more preferably a period of less than about 100ms from the opening of the seal 149.

In one embodiment, the delivery unit 120 provides for delivery of the substance to begin less than about 150ms after the opening of the seal 149, preferably less than about 100ms after the opening of the seal 149, preferably less than about 50ms after the opening of the seal 149, more preferably less than about 25ms after the opening of the seal 149, and even more preferably less than about 15ms after the opening of the seal 149.

In this embodiment, outlet unit 167 comprises a nasal airway nozzle 171 for delivering a substance to a subject. In the present embodiment, the nozzle 171 is configured to provide an aerosol spray. In an alternative embodiment, for delivery of the liquid, the nozzle 171 may be configured to deliver a liquid jet in the form of a liquid column.

In a preferred embodiment, the distal end of the outlet unit 167 is configured to extend at least about 2cm, preferably at least about 3cm, and more preferably from about 2cm to about 3cm into the nasal cavity of the subject.

In this embodiment, the substance supply unit 169 is a pump unit comprising a substance-containing chamber 173 containing a substance and extending from the aperture 123 into the housing 115 as an actuating portion of the substance supply unit 169, and a mechanical delivery pump 175 which can be actuated here by depressing the substance-containing chamber 173, typically by a subject's finger or thumb, so as to deliver a prescribed dose of the substance, here in the form of an aerosol spray, from the substance-containing chamber 173 to the outlet unit 167 and from its nozzle 171.

In this embodiment, the substance-containing chamber 173, when depressed to actuate the substance supply unit 169, engages the lower arm section 151 of the arm 141 of the valve element 131, such as to simultaneously provide actuation of the substance supply unit 169 and opening of the seal 161 of the valve element 131, whereby a substance, here in the form of a spray, and an air stream, here in the form of a burst of air, are simultaneously delivered to the nasal cavity of the subject.

In this embodiment, the mechanical delivery pump 175 is a liquid delivery pump for delivering a metered dose of substance, but in an alternative embodiment, the mechanical delivery pump 175 may be a powder delivery pump that delivers a metered dose of a powdered substance upon actuation thereof.

In this embodiment, the substance supply unit 169 is a multi-dose unit for delivering a plurality of doses of a prescribed substance in successive delivery operations.

In alternative embodiments, the substance supply unit 169 may be a single dose unit for delivering a single dose of a substance or a double dose unit for delivering two doses of a substance in two successive delivery operations.

In another alternative embodiment, the substance supply unit 169 may comprise a dry powder delivery unit that delivers a prescribed dose of substance in dry powder form upon actuation thereof.

In yet another alternative embodiment, the substance supply unit 169 may comprise a nebulizer that delivers a prescribed dose of substance in the form of an aerosol spray upon actuation thereof.

In yet another alternative embodiment, the substance supply unit 169 may comprise an aerosol canister that delivers a specified volume of propellant, preferably a Hydrofluoroalkane (HFA) propellant or the like, containing the substance, either in suspension or in solution.

In this embodiment, the housing 115 further comprises a seal 181, here an annular seal in the form of an O-ring, which slidably receives the substance-containing chamber 173 of the substance supply unit 169, such as to prevent escape of the delivered airflow from the aperture 123 in the housing 115.

In one embodiment, the seal 181 may be omitted.

Fig. 8(a) and (b) show a nasal delivery device according to a second embodiment of the present invention.

The delivery device of this embodiment is substantially identical to the delivery device of the first embodiment described, and thus only differences will be described in detail to avoid unnecessary redundancy, wherein like reference numerals indicate like parts.

The delivery device of this embodiment differs from the first described embodiment essentially in that the valve element 149 is configured such that the support 163 extends across substantially the entire width of the valve opening 130. In this manner, the seal 161 cannot bulge as in the above-described embodiment, but is opened by the peeling action. Fig. 8(a) shows the valve assembly 127 in a rest, non-actuated configuration. Fig. 8(b) shows the valve assembly 127 in an actuated configuration.

Fig. 9(a) and (b) show a nasal delivery device according to a third embodiment of the present invention.

The delivery device of this embodiment is very similar to the delivery device of the first embodiment described and therefore only differences will be described in detail to avoid unnecessary redundancy, wherein like reference numerals indicate like parts.

The delivery device of the present embodiment differs from the first described embodiment essentially in that the seal 161 is not supported by the arm 141, but is a separate element which is moved by the movement of the arm 141 caused by manual actuation of the substance supply unit 169. Fig. 9(a) shows the valve assembly 127 in a rest, non-actuated configuration. Fig. 9(b) shows the valve assembly 127 in an actuated configuration.

In this embodiment, the seal 161 comprises a flexible element, here in the form of a flap, and in one embodiment a resilient element, which is engaged by the engagement element 185 on the arm 141.

In the present embodiment, the engagement element 185 includes a protrusion that acts to cause the seal portion 161 to bulge in the manner of the first embodiment described.

In an alternative embodiment, the engagement element 185 may extend substantially across the width of the valve opening 130, causing the seal portion 161 to move from the valve seat 129 by a peeling action in a manner similar to that described for the second embodiment.

Finally, it should be understood that the present invention has been described in its preferred embodiments and can be modified in many ways without departing from the scope of the invention as defined by the appended claims.

Claims

1. A nasal delivery device for delivering a substance to a nasal airway of a subject, comprising:

a nosepiece for mounting to a nasal cavity of the subject;

a mouthpiece into which the subject exhales in use;

a delivery unit comprising an actuation portion manually movable to actuate the delivery unit to deliver the substance from the nosepiece; and

a valve assembly fluidly connected to the nosepiece and the mouthpiece, wherein the valve assembly comprises a body element and a valve element movably disposed to the body element, the valve element being movable between closed and open configurations by manual movement of an actuation portion of the delivery unit to provide a flow of gas through the nosepiece while simultaneously moving between closed and open configurations for substance delivery;

wherein the body element contains a valve seat defining a valve opening, the valve element comprising a sealing portion having a central region and a peripheral region and operative to close the valve opening when the valve element is in a closed configuration, and a support portion supporting the central region of the sealing portion, whereby the peripheral region of the sealing portion engages the valve seat when the valve element is in a closed configuration and the central region of the sealing portion deflects relative to the peripheral region of the sealing portion when the valve element is moved to an open configuration, thereby allowing for an abrupt release of the sealing portion.

2. The delivery device of claim 1, wherein the body element includes a pivot, the valve element including an arm having one end pivotally connected to the pivot of the body element between the closed and open configurations.

3. The delivery device of claim 2, wherein the arms are at least partially elastic.

4. The delivery device of claim 2, wherein the body element includes a sliding surface against which the other end of the arm is slidable.

5. The delivery device of claim 2, wherein the arm comprises a first arm segment configured to be engageable by movement of an actuation portion of the delivery unit when the valve element is in a closed configuration.

6. The delivery device of claim 5, wherein the arms are biased inwardly with respect to a longitudinal axis of the delivery device.

7. The delivery device of claim 5, wherein the arms are angled inwardly relative to a longitudinal axis of the delivery device when the valve element is in the closed configuration.

8. The delivery device of claim 5, wherein the first arm segment comprises a substantially rigid segment.

9. The delivery device of claim 5, wherein the arm includes a second arm segment that engages a sliding surface of the body element.

10. The delivery device of claim 9, wherein the first arm segment and the second arm segment enclose an obtuse angle.

11. The delivery device of claim 9, wherein the second arm segment is a resilient segment that acts to bias the valve element to a closed configuration.

12. The delivery device of claim 1, wherein the seal comprises a resilient element.

13. The delivery device of claim 1, wherein the valve assembly provides a burst of airflow having an initial first burst phase followed by a prolonged second burst phase when the valve element is open, wherein a maximum flow rate in the first burst phase has a flow rate greater than an average flow rate in the second burst phase, and the second burst phase has a duration substantially longer than the first burst phase.

14. The delivery device of claim 13, wherein the maximum flow rate in the first burst phase is at least 10% greater than the average flow rate of the second burst phase over a period corresponding to ten times the duration of the period of delivery of substance from the delivery unit.

15. The delivery device of claim 14, wherein the maximum flow rate in the first burst phase is at least 15% greater than the average flow rate of the second burst phase over a period corresponding to ten times the duration of the period of delivery of substance from the delivery unit.

16. The delivery device of claim 15, wherein the maximum flow rate in the first burst phase is at least 20% greater than the average flow rate of the second burst phase over a period corresponding to ten times the duration of the period of delivery of substance from the delivery unit.

17. The delivery device of claim 1, further comprising:

a housing including an aperture through which an actuation portion of the delivery unit extends.

18. The delivery device of claim 17, wherein the housing further comprises a seal slidably receiving the actuation portion to prevent air from flowing out of the aperture in the housing.

19. The delivery device of claim 1, wherein the valve assembly provides a pre-actuation performance of less than 5L/min when the subject is developing an exhalation pressure of 3 kPa.

20. The delivery device of claim 19, wherein the valve assembly provides a pre-actuation performance of less than 5L/min when the subject is developing an exhalation pressure of 10 kPa.

21. The delivery device of claim 19, wherein the valve assembly provides a pre-actuation performance of less than 1L/min when the subject is developing an exhalation pressure of 3 kPa.

22. The delivery device of claim 19, wherein the valve assembly provides a pre-actuation performance of less than 1L/min when the subject is developing an exhalation pressure of 10 kPa.

23. The delivery device of claim 19, wherein the valve assembly provides a pre-actuation performance of 0L/min when the subject is developing an exhalation pressure of 3 kPa.

24. The delivery device of claim 19, wherein the valve assembly provides a pre-actuation performance of 0L/min when the subject is developing an exhalation pressure of 10 kPa.

25. The delivery device of claim 1, wherein the delivery device is configured to provide at least 80% of the air delivered into the mouthpiece to the nosepiece when delivered at a flow rate of 50L/min and an exhalation pressure of 3 kPa.

26. The delivery device of claim 25, wherein the delivery device is configured to provide at least 88% of the air delivered into the mouthpiece to the nosepiece when delivered at a flow rate of 50L/min and an exhalation pressure of 3 kPa.

27. The delivery device of claim 24, wherein the delivery device is configured to provide at least 90% of the air delivered into the mouthpiece to the nosepiece when delivered at a flow rate of 50L/min and an exhalation pressure of 3 kPa.

28. The delivery device of claim 1, wherein the delivery unit provides for delivery of the substance after the valve element is opened.

29. The delivery device of claim 28, wherein the delivery unit provides for delivery of the substance in a period of less than 250ms from the opening of the valve element.

30. The delivery device of claim 29, wherein the delivery unit provides for delivery of the substance in a period of less than 200ms from the opening of the valve element.

31. The delivery device of claim 29, wherein the delivery unit provides for delivery of the substance in a period of less than 150ms from the opening of the valve element.

32. The delivery device of claim 29, wherein the delivery unit provides for delivery of the substance in a period of less than 100ms from the opening of the valve element.

33. The delivery device of claim 28, wherein the delivery unit provides for delivery of the substance to begin within less than 150ms after opening of the valve element.

34. The delivery device of claim 33, wherein the delivery unit provides for delivery of the substance to begin less than 100ms after opening of the valve element.

35. The delivery device of claim 33, wherein the delivery unit provides for delivery of the substance to begin within less than 50ms after opening of the valve element.

36. The delivery device of claim 33, wherein the delivery unit provides for delivery of the substance to begin within less than 25ms after opening of the valve element.

37. The delivery device of claim 33, wherein the delivery unit provides for delivery of the substance to begin within less than 15ms after opening of the valve element.

38. The delivery device of claim 1, wherein the delivery unit comprises an outlet unit from which substance is delivered through the nosepiece and a substance supply unit actuable to deliver substance to the outlet unit.

39. The delivery device of claim 38, wherein the outlet unit comprises a spray nozzle.

40. The delivery device of claim 38, wherein the actuation portion of the delivery unit comprises a substance-containing chamber of the substance supply unit.

41. The delivery device of claim 40, wherein the substance supply unit comprises a mechanical delivery pump actuable by depression of the substance-containing chamber.